Acute alcohol intoxication characteristics in children.

AIMS: To describe clinical, mental and physical signs in children with different severity acute alcohol intoxication (AAI) determined either by serum alcohol concentration (SAC) or by blood alcohol concentration (BAC) to study the diagnostic performance characteristics of clinical assessment and to establish the ratio of SAC:BAC in children. METHODS: Data were analysed from 256 children aged 8.4-17.9 years who were hospitalized at Estonia's two children's hospitals over a 3-year period. In each case, the on-call paediatrician completed a special form about the clinical, mental (consciousness, balance and speech) and physical (muscle tone, blood pressure, pulse and body temperature) signs of AAI. Blood samples were drawn for measurements of SAC and BAC. Diagnostic performance characteristics (sensitivity, specificity, efficiency) of the clinical assessments and the SAC:BAC ratio were calculated. RESULTS: The most correctly described signs in children in different SAC groups were consciousness (rs = 0.16) and speech (rs = 0.13) (P < 0.0001). The severity of alteration of consciousness and degrees of disturbance in balance and speech were positively correlated with SAC (P < 0.001). The clinical judgment matched better with AAI determined by SAC rather than by BAC with the mean efficiency. The mean ratio between SAC and BAC was 1.19 ± 0.13 (P < 0.001) in children. CONCLUSION: The level of consciousness is the leading sign in the clinical evaluation of children with AAI and correlates well with SAC. The severity of AAI judged by clinical assessment matched better with AAI severity stages determined by SAC than by BAC. For legal cases where BAC is required, the SAC:BAC ratio of 1.19:1 should be used in children regardless of their gender or age.

Glycated haemoglobin (HbA1c) for postmortem diagnosis of diabetes.

The study was conducted at the Estonian Forensic Science Institute in 2008-2014 as continuous part of our previous study of alcohol and premature death in Estonian men. Autopsy data from 504 cases of male deaths (ages 19-79) were collected and blood and urine samples for glycated haemoglobin (HbA1c), liver enzymes and alcohol concentration were analysed. The aim of our research was to find undiagnosed diabetes and diabetes risk cases postmortem on the basis of increased values of HbA1c. HbA1c was within the reference value 4.8%-5.9% (29-42 mmol/mol), in 88.1% (n = 444) of cases, below reference value in 2.4% (n = 12), in the risk group of diabetes, HbA1c 6.0%-6.4% (42-46 mmol/mol) was within 5.8% (n = 29), and HbA1c result of ≥6.5% (48 mmol/mol) manifested in 3.8% (n = 19) of cases. The higher the age, the more cases with HbA1c value ≥6.0% (42 mmol/mol) occurred. In the group of external causes of death (n = 348), the HbA1c value of ≥6.5% (48 mmol/mol) HbA1c occurred in four cases. The HbA1c value was ≥6.5% (48 mmol/mol) in 78.9% of 156 cases when the cause of death was disease, of which 58% were cardiovascular diseases. The prevalence of diabetes and diabetes risk was found lower compared to population-based study, as majority of the deceased were young and middle-aged males and no females were included. In the case of poisoning with narcotic substances, HbA1c was within the reference range. A negative correlation occurred between alcohol intoxication and HbA1c value. A positive correlation between ALT and HbA1c was found - the higher stage of liver damage correlated with the higher HbA1c level.

Comparison of injuries caused by the pistols Tokarev, Makarov and Glock 19 at firing distances of 10, 15 and 25cm.

Firings at cloth targets and at human skin from autopsy material were performed from the pistols 7.62 mm Tokarev (TT), 9 mm Makarov (PM) and 9 x 19 mm Glock 19 with common ammunition. The differences were in the soot deposit pattern, the degree of scorching of the synthetic fibres on the edges of the entrance hole and in the findings of the soot and the gunpowder particles. The results were similar on the cloth and on the skin targets. In the case of the TT and the PM, the soot deposit patterns reminded of a blossom or shafts of rays or fans, or the bullet wipe had four narrow and four wide sections regarding the number of lands and grooves. The TT left a large amount of soot and many gunpowder particles and caused the melting of the synthetic fibres on the edges of the entrance hole, producing a defect of the material 0.1-0.3 cm in diameter and defects of textile fibres around the entrance hole. In the skin the TT caused many intraepithelial tears, folds of the epidermis and recesses of the epidermis containing soot. Firings from the PM and the Glock 19 caused the melting only of the ends of individual synthetic fibres on the edges of the entrance hole. The PM left a large amount of soot and only a few gunpowder particles. The Glock 19 gave the least soot and the greatest number of gunpowder particles and also caused tears and recesses in the epidermis. Only in the case of the Glock 19, hexagonal or polygonal zones were seen in the soot deposit pattern. The differences in the soot pattern were more distinct at the firing distance of 10 cm. By increasing the distance from 10 to 15 cm, the intensity of soot diminished and began to disappear at 25cm, but remained more visible in the case of the TT. The gunpowder particles could be found in the epidermis and deeper in both layers of the dermis at all distances fired from the TT and the Glock 19. In the case of firings from the PM, at the distance 10 cm some of the gunpowder particles had penetrated into the dermis and most of them were in the upper layer of the dermis. At the firing distance of 15 and 25 cm, the gunpowder particles were only on and in the stratum corneum.

Characteristics of cardiovascular deaths in forensic medical cases in Budapest, Vilnius and Tallinn.

Evaluation of the pathomorphological characteristics of cases involving natural and sudden cardiovascular death is essential for the determination of the cause of death. The main purpose of this study is to investigate sudden unexpected cardiovascular death and to study how different geographical climatic influences may affect cardiac mortality in three capitals: Budapest, Vilnius and Tallinn. There were 8482 (5753 male, 2729 female) cardiovascular deaths between 2005 and 2009. The highest rate was observed in the age group between 71 and 80 years (35.17%) and 51-60 years (24.45%). The highest number of cardiovascular deaths occur in January (805/9.49%) and December (770/9.07%). Seasonal distribution was observed, with winter prevalence in Tallinn (279/3.20%) and spring prevalence in Vilnius (760/8.90%). Though in Vilnius and Budapest a great number of deaths occurred in winter and spring, any correlation with other factors (e.g. age, gender, BAC) was not statistically significant. Based on our results we can conclude that environmental-geographical parameters may affect natural cardiovascular death. Examination of pathological patterns and predisposing environmental parameters may help to improve prevention strategies.

Fatal traffic injuries among children and adolescents in three cities (capital Budapest, Vilnius, and Tallinn).

Motor vehicle accidental injuries are a frequent cause of death among young children and adolescents. The goal of this study was to compare patterns of injury between three capitals (Budapest, Vilnius, and Tallinn). Information on 190 fatal traffic accidents (69 pedestrians, 14 bicyclists, and 107 motor vehicle occupants) between 2002 and 2006 was collected from databases of medico-legal autopsies. The role of victims in accidents, the location of injuries, cause of death, survival period, and blood alcohol levels were evaluated. One-hundred and forty-one (74%) victims had a passive role in traffic as pedestrians, passengers in cars, or public transport. In victims who died at the scene, the rate of head injury was higher than in cases who received medical treatment (odds ratio = 2.58, CI = 1.2-5.55, p = 0.0127). These results underline the importance of postmortem studies to examine the pathomechanism of fatal traffic accidental injuries and to provide information for the prevention of road traffic accidents against children and adolescents.

Comparison of gunshot injuries caused from Tokarev, Makarov and Glock 19 pistols at firing distances of 1, 3 and 5 cm.

Test shots at cloth and at human skin from autopsy material were performed with 7.62 mm Tokarev (TT), 9 mm Makarov (PM) and 9 × 19 mm Glock 19 pistols, using common ammunition. The largest central material defects, with fibre deformation in cotton, the largest burn holes in polyester, and also many fibre defects caused by the perforation of powder, were produced in shots from the TT at all distances. Tears in the cloth were longest in the case of the TT at 1 cm and were present at 3 cm, whereas the shots from the PM and the Glock 19 did not leave tears. There were small tears of the edges of the skin defect from shots fired from the TT at 1 and 3 cm. On cloth-soot deposits at 3 and 5 cm, the radial structures of soot resembled a cobweb (the TT), and radial branching structures (the PM) of soot were seen. Some shots from the PM left four shafts of rays of soot and formed the bullet wipe with four narrow and four wide sections, indicating the form of rifling. In the soot deposit from the Glock 19 with hexagonal rifling, hexagonal or polygonal or petal-like areas were visible. On skin, the soot zones were less distinct. The Glock 19 (at 3 and 5 cm) left a lot of gunpowder particles densely around the cloth and skin defect. The least powder left on the cloth and skin was by the PM. On histological tissue sections, in shots from the TT, a lot of soot and gunpowder residue particles in the epidermis and in both layers of the dermis, and intraepithelial tears and recesses containing soot, were seen. The PM left fine soot and only a few gunpowder particles in the epidermis and in the papillary layer of the dermis. The Glock 19 produced the least soot and a lot of gunpowder particles. The soot and most of the gunpowder particles were present on the tissue sections, which originated from the central area around the skin defect and were detected in the epidermis and in both layers of the dermis. Some tears and recesses in the epidermis were also seen. The further the distance from the centre of skin defect to the periphery, the depth of the penetration of the powder into the skin decreased.

Comparison of injuries caused by the pistols Tokarev, Makarov and Glock 19 at firing distances of 25, 50, 75 and 100 cm.

Firings in the horizontal direction at cloth targets and at human skin from autopsy material were performed using the pistols 7.62 mm Tokarev (TT), 9 mm Makarov (PM) and 9 mm x 19 mm Glock 19 with common ammunition. On cloth targets, soot was more visible in the case of the TT up to firing distance of 50 cm and there were faint soot flecks on some synthetic cloths even at a distance of 75 cm. In the case of the PM and the Glock, the soot was seen on some synthetic cloths at a distance of 50 cm. The gunpowder particles were dispersed over the targets (TT and PM) or concentrated mostly around the bullet entrance hole (Glock 19). Up to a distance of 75 cm, the Glock 19 left the greatest and the PM the smallest number of gunpowder particles. At a distance of 100 cm, there were only some gunpowder particles on the cloths. On skin targets, starting from a distance of 25 cm (Glock 19) and 50 cm (TT and PM), no more soot was macroscopically visible. Histological examination revealed few dotted deposits of soot (TT and PM) and finer soot particles (PM) on the skin surface up to 50 cm. At a distance of 25 cm, the gunpowder particles were found in the epidermis and deeper in the dermis (TT and Glock 19), and a distance of 50 cm they were on and in the stratum corneum. Starting from a distance of 50 cm, in the case of the PM we detected many partially burnt gunpowder grains not connected with the skin surface. At a distance of 75 cm, the gunpowder particles were on the skin surface, except one or two of them found in the stratum corneum (TT and PM), and at a distance of 100 cm, the particles were only on the skin surface.